Increased protein binding & Lipid solubility

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Increased protein binding & Lipid solubility



Garcia &Gutierrez, Weine



19 days



Coronal (Due to increased substrate & larger dentinal tubules)
Rubach, Mitchell, Seltzer
Unpredictable extent & duration

Type III

Curetting the sinus tract


Melzack & Wall

Endo Ice/Cold tests

Vertical root fracture



Binary Fission


Ethylene Diamine Tetraacetic Acid



Gutta Percha

Specificity theory of pain

All Bond 2 Composite

Orofacial Pain

Mandibular 1st Molars

Seltzer & Bender

Streptococci (aerobes)




3 months

IL-1 Beta & TNF-Beta


3 Days

Cause Expansion

Baumgartner & Harrison

Formation of Irritation Dentin

Czarnecki, Schilder, Mazur, Massler

Clavulonic Acid

Angled wire measurement films


Walia, 1988

Seltzer & Bender


Clindamycin (14%)

Abou-Rass (1982)




Mattison & Delivanis (1984)

Good bone penetration



Anticurvature Filing

Kantz & Henry


3.2 grams

Referred Pain

Calcific Metamorphosis

1-3 kg

Kakehashi’s germ free rat study

Releases Ca++ ions

Yared & Bou Dagher

Trigeminal Neuralgia & atypical facial pain


Biomechanical & Chemomechanical

Griffee & Sundqvist


Cohen, Cha, & Spangberg

A good restoration

Phoenix Abscess


Stanley & Fitzgerald




Extension of the abscess

Continuous Tapered Funnel

Van Hassel


Without Food





Heithersay (1973)

4 grams

2 years

The epithelium lined cavity is open & continuous w/ the foramen

of the root canal

Remove 3mm GP & place an intra-orifice filling (Cavit, IRM, EBA)


10ml 17% EDTA, followed by 5.25% NaOCl

A delta nerve fibers

Periradicular Cemental Dysplasia


Focal Infection

5-10 Minutes


Chronic Periradicular Abscess

Alpha (from the Thebaine Tree)
Infection (Bacteria/PMNs)-abscess center; contamination(Bact

toxins/lymphocytes/macrophages)-abscess wall; irritation

(macrophages/osteoclasts/lymphocytes/plasma cells)-

granulomatous zone; stimulation(osteoblasts/fibroblasts)-capsule

Major & Minor diameters

Chronic: No symptoms

Acute: Produces pain on biting & percussion



Hutchinson’s Incisors (Mulberry Molars)

Pseudomembraneous Colitis

Stressed Pulp

Destruction, Infected Tubules, Demineralization, Sclerosis



Cox 2


Dental Granuloma

Roane & Sabala, 1985

Bacteroides melanogenicus

1.5 micrometers/day


Partial or total necrosis

Periradicular Cyst (AAE 2003)



Necrotic Layer of Tissue

6 grams

Under 30 days

Pocket Cyst


Sundqvist (JOE 1992 Sep)

Canal obliteration & internal resorption

Prophylactic Antibiotics


B/c more pain occurred after pulpectomy & trephination,

vs. pulpectomy alone


Factor X

No effect on the overall success

Walton & Fouad (1992), Torabinejad (1994), Imura (1995)


Faster (less than 15 days)

INR (International Normalized Ratio)


Mandibular Pre-Molars

3.1% (Close to Trope’s 2.6% in 1990)

Glass Ionomer

Fibroblasts (possibly odontoblasts)




Flare-Up (AAE 2003)





Only 3%

Harrington & Natkin

Flame Heated Carriers

Chondroitin Sulfate

Contraction of the vascular smooth muscle

Birchfield & Rosenberg


Female, Allergies, Hx of Pre-Op pain, No or small PARL,

Ages: 40-59, Re-Tx


Fibrocytes & small blood vessels

Bone Marrow

Middle aged African-American Woman (Mostly Antr Mand)

Bence & Meyers (1980), Weine (1975-Fewer Exacerbations),

Simon (1982-Foreign Body Rxn if left open)

47 Degrees Celsius for one minute (10 Degrees rise on the




Hyperplastic Pulpitis

August (1982)


Dermatin Sulfate, Heparin Sulfate, Hyaluronic Acid,

Chondroitin Sulfate

Plasma Proteins

.72mm (thus the reason we instrument .5-1mm short)

Overgrowth of Facultative Anaerobes

Preflaring of the canal

Dead Tracts

Composite (Specifically Geristore)


Wilcox & Walton 1989

Dentin dysplasia


McComb & Smith

Type IV

Kuttler 1955

5 minutes


1-2 micrometers, 40 micrometers

5 REM/year


2nd Premolars & MB canals of max molars

Open Apices




Weine, 1969

Overinstrument, Overmedicate, Debris extruded, incomplete

removal of pulp, recrudescence of CAP, overirrigation, hyper-

occlusion, root fracture, another tooth, Pasteur Effect





Removal of smear layer, epoxy resin sealer (AH 26), &

vertical compaction after obturation
Epstein-Barr Virus

Beta phase (normally), transforms to alpha phase btwn

42-49’C,& then into amorphous phase btwn 53-59’C.
A beta

Type III
Due to its vasoconstriction effects

Taylor, Jeansonne, & Lemon

Primordial Cyst

ZnO (59-75%)  GP= 19-22%

Dentin Sclerosis

Spinal Tract Nucleus





Pentophosphate Shunt

Connective, Muscle, Nervous, & Epithelial
Johnson & Remeikis

Extreme Widening of the PDL

3-4 weeks (same as with root fractures)

Sunada 1962

Rickert & Dixon 1931

Ferric Sulfate


  1. Doxycycline application to root, 2. Flouride soak (5 min-if out

of mouth > than 60 min), 3. PenVK or doxycycline systemic

therapy, 4. CHX mouth rinse, 5. Tetanus shot if not up to date

Seltzer & Bender 1963


7 micrometers
Barnett (J Perio, 1985) Bainton (OOO 1986)

Fogel & Peikoff (1994) with 71%


0-2mm Short

150-200 micrometers


Hume, Kim

Cooke & Cox

22%, 8.5% (Thus no justification to ‘automatically’ do the RCT)


False Dentricles


4 hours

D speed

Blomlof & Lindskog (1983)

Dual Frequency

Goldman & Pearson

Glossopharyngeal Neuralgia

Bone Wax

Angled Radiographs

5 Years


PMNs & inflammatory mediators

Type II
A combining of drugs which results in a response greater

than expected (1+1=4)

Infection & attachment damage

Davis & Joseph 1971

Dental Sac

Calcitonin & PTH


Bone & Moule (1986); 85% of roots examined curved greater

than 10 degrees



Autonomic Sympathetic


Tegretol (Carbamazepine)

60% (they join)

External Root Resorption


Collagen/noncollagenous protein

Block, Wemes, Araki



Instrumenting the MB completely first





Hedstrom File

Van Hassel (As well as Tonder & Kvinnsland)




Dentigerous Cyst




750 mg Acetominophen, 7.5mg Hydrocodone

40% (they join)

Open Apex/More than 1 hr dry time


Von Korff’s Fibers

Maintain adequate blood level dosages

Slowly increasing the current

Frances Andreasen

Cleansing & shaping without obturation




Law of centrality, Law of CEJ, Law of symmetry, Law of color

change, Law of orifice location (wall & floor), Law of orifice

location (fusion lines)

60 Minutes

Yield Point


25 days

That prophylactic antibiotics have no significant benefit on

post-endo flare-ups or pain


Room Temperature


Heparin Sulfate

Filiform, Fungiform, Circumvallate, Foliate



Nasopalatine Duct cyst


The inflammatory response

Keratoconjunctivitis sicca, Xerostomia, Rheumatoid arthritis

Yamasaki & Stashenko






Kulild & Peters (1990)

Crown fracture with pulp exposure

Incremental filing (Step-back Filing)


Kaposi’s Sarcoma



Andreasen 1981

42% ZnO & 27% Stabilite Resin

<100 micrometers (<1/3 of the way to the DEJ)

Multiple Myeloma

Placebo, PenVK, & Erythromycin

Root curvatures

Ludwig’s Angina

#40 MAF

Arterio-venous shunts


Bellizzi (1985)



Undifferentiated Mesenchymal Cells

Trope (& Sae-Lim 1998 EDT)


Herpes Zoster

Less debris extrusion

Blood vessel walls

Geographic Tongue

Racemic Epinephrine (1:1000)


Type 5


Lymphatics, Veins

Abnormal generalized widening of the PDL


Bender & Seltzer

Replacement resorption of the root (Andreasen 1989)

Davis & Joseph 1971

Superior Cervical Ganglion

Incomplete nonsurgical debridement & obturation

9 days

50 %

CHX (after scraping off cementum)

Triangular & Square


Jeansonne, Boggs, & Lemon (JOE 1993 Apr)

4% prilocaine & 3% mepivicaine




Mast cells

Sensitivity or pain caused by change in pressure (Cunningham)

19% formaldehyde, 35% cresol, glycerine, & water

Stimulate A-delta fibers


Size #35 MAF

B Cells


Seidberg & Schilder


True; may be an example of transient ‘sterile’ inflammation

secondary to trauma (Andreasen 1986)
Dunlap & Remeikis




Long periods (vs 1-2 weeks)

Kuttler, D. Green, Burch & Hulen, Glatt

Antigen Presenting Cell

Calcium Sulfate

Abou-Rass, Cunningham

Brothel & Roulet

Germ free rats still developed ankylosis, but no inflammation

or necrosis of the pulps was present

Double-Flared technique (crown-down variation)

Dendritic cells


Hasselgren, Cvek, Olson

90% (1999 EDT)

Andreasen 1985

Rotstein (1999 JOE)

Lines of Von Ebner

Schroder 1971



Mechanowicz & Abou-Rass 1971

1. Permits better debridement of apical preparation, 2. Reduces

overinstrumentation, 3. Improves the ability to obturate


Langeland (1974)

Salzgeber, Brilliant


Intrusion (>96% necrosis)

Bystrom & Sundqvist (1981): Need to have two visits for

necrotic teeth, with CaOH in between
To the CDJ/DEJ

Simon, Glick & Frank 1972


Andreasen & Rud (J Oral Surg 1972)

Rests of Malassez


1/3 of the way to the DEJ/CDJ

Gargiulo & Orban 1967


1. Fibrous CT(Like fibrous healing of bone, fx edges appear

smooth, calcification of canal system), 2. Osseous & CT

(Interposition of bone btwn segments-pulp is vital), 3. Calcific

Tissues (1` when segments are close; (-) perc/palp & pulp is

vital, 4. Granulation (when non-union healing occurs; coronal is

necrotic & mobile; apical segment is viable  gap & sinus tract)

Walia, Brantley, & Gerstein 1988


Complete, Incomplete (Scar), Uncertain, Unsatisfactory

External Root Resorption


Open Apex Teeth (34% healing)

Cavit & Oraseal

To the CDJ/DEJ



Calcified Callus, Fibrous Callus, Bony Ingrowth,

Granulation Tissue
Triangular (Pilet & Sorm 1973)


Seltzer & Bender

3 months


Austentite & Martensite

1-2 micrometers

Primary Endo, Primary Perio, Primary Endo w/ Secondary Perio,

Primary Perio w/ Secondary Endo, True Combined Lesion






Sulcus depth ~1mm, Epithelial Attachment ~1mm,

& CT Attachment ~1mm



No (Andreasen 1967, in contrast to Bender & Friedland 1967)

.19mm (Stein & Corcoran 1990)


2nd Premolar
Periaqueductal grey &/or nucleus caudalis

Cancer (metastasis appear as PARL), Trigeminal Sensory

Neuropathy: CNS metastatic CA or multiple sclerosis,

Infection (resolved with NSRCT)

Vitality of PDL cells (Presence of the Rests of Malassez)


100-150 micrometers



Ag Amide Hydrate (Cytotoxic)

CaOH treatment after splinting

Base: CaOH (25%), Catalyst: Barium Sulfate (18.6%)

C Fibers


Barnes, Langeland

EPT (Worse), Dry Ice (Best)



Bergenholtz 1974 (primarily polymicrobial anaerobic bacteria)

1.5-2.0mm (even after 72 hours of traumatic exposure!)

Anti-penicillinase Properties



.3-.5mm large (Yard & Bou Dagher 1994)

Dentin Sclerosis

Oynick & Oynick (JOE 1978)


Degree of mobility of the coronal segment

Fuss 1996


Cambruzzi, Marshall & Pappin


Kerekes & Rowe (1982)

1. Injury to PDL, 2. Initial external resorption exposing dentinal

tubules, 3. Necrotic & infected pulp communicating w/ resorbed

area via tubules, 4. Poss bacteria on PDL, 5. Age of tooth

Binding agent for RC core filling material, Fills voids &

discrepancies in canal walls, Prevents leakage, Acts as a

lubricant for fill


Erythema Multiforme

Clostridium Difficile

Seltzer & Green (1972)


Spangberg (but this is primarily due to large size of GP)

Anachoresis (Gier & Mitchell 1968)

Remove the blood clot


4 years




Abbott, Daren, Senia


Perm tooth, extraoral dry time > 60 min, & open apex

ZnO (42%) Filler, Antimicrobial

A delta & C fibers

Haas 1995



GP in the beta phase will shrink even after warm compaction


Albright’s Syndrome

.12% CHX Gluconate

Rud & Andreasen

Contact Lens Solution


Bacteroides melanogenicus

Parotid Gland

Cvek & Cleaton-Jones 1990

An intact blood supply

External surface resorption, Internal surface resorption,

Internal tunneling resorption, Transient apical breakdown

Heavy metal sulfates (1-17%)

Waxes & Resins (1-4%)

Pigments (.1-.3%)


Suture Removal (5 or more sutures)


Howship’s Lacunae (with occasional osteoclasts)

Retards setting time

Microfilaments & Microtubules


Long acting LA, Amoxicillin for 5 days, Analgesic, Steroid,

& cold compress

Pain on biting or release, sensitivity to thermal changes,

persistent dull pain, pain to selective cuspal percussion,

presence of fracture lines (transillumination/meth blue),

deep narrow perio pockets, ‘halo’ PARL

Little Shrinkage

4 micrometers, 1 micrometer


1% NaOCl through a perforation site (max incisor in this case)

Rubenstein & Kim




Osteogenesis Imperfecta

Bone Wax

Psychogenic-Manchausens, Inflammatory-Sinusitis,

Neurovascular-Cluster Headaches, Systemic-Myocardial

Infarct, Musculoskeletal-Myofascial Pain-TMD




Paget’s Disease
An increase in Lithium
Periapical Cemental Dysplasia-Cementoma, Focal Sclerosing

Osteomyelitis, Idiopathic Sclerosis, Cementoblastoma, Calcifying

Odontogenic Cyst-Pindborg, Calcifying Epithelial Odontogenic

Tumor, Adenamatoid Odontogenic Tumor


ZOE Sealers

Dental Papilla

Addison’s Disease

Dec metabolism of Warfarin (thus inc blood levels)

At least 3 months


Roth’s 801

Dental Sac

Bull’s Eye Lesions



15% Cysts (True: 9%, Pkt: 6%), 50% Granulomas,

35% Abscesses

1 mm


Dens Invaginatus

.2 mg

Trans-illumination & Methylene Blue Dye


AH 26 (due to formaldehyde, which isn’t in AH26+)


Fibrous Dysplasia
Rebound phenomenon or reactive hyperemia

Granuloma, Cyst, Abscess, Foreign Body Rxn, OKC,

Multilocular Ameloblastoma, CGCG, Metastatic Malignancy
Garre’s Osteomyelitis

Gives body, coherence & a good setting time

Dental Papilla


An inc in Digoxin via inhibition of GI flora

Poor Endo/Good Crown: 68%, Poor Endo/Poor Crown: 18%,

Good Endo/Good Crown: 91%, Good Endo/Poor Crown: 41%
Craze Lines, Cuspal Fx, Cracked Tooth, Split Tooth, Vertical

Root Fx
Because of its eugenol (Micke & Wright 1999)

Dystrophic Calcification

Frey’s Syndrome

Tricyclic antidepressants (enhanced sympathetic effects), non-

selective B blockers (propanalol = HTN), halothane (cardiac

arrhythmias), cocaine (HTN, arrhythmias)

Mucins (saliva) or bacteria, instead of dyes

Epithelial Proliferation, Cavitational Breakdown Theory,

Breakdown Theory of Cyst Formation, Immunological Theory



7 days

Vancomycin & Metranidazole (Neither are absorbed into the gut)


Toller: Osmotic pressure builds up due to semi-permeable

membrane (Starling’s law)
MTA (93%), Osteogenic Protein-1 (~40%), & CaOH (~40%)

Prevotella, Fusobacterium, Lactobacillus, Porphymonas,

Veillonella, Pepto/Streptococci, Eubacterium, Actinomyces,


Osteogenesis Imperfecta
Gram+ & Gram- strict anaerobes

Max 1st bicuspid (Torabinejad 1992)


Cooke & Grower (1976), Marshall & Massler (1961)

Gram+ facultative anaerobes (treatment resistant)

Dentinogenesis Imperfecta

Facultative Organisms

No; Papa & Messer 1994  12.1% moisture in RCT teeth,

12.4% in vital dentin
50/50 (Same as Leubke/Lalonde)

Cunningham, Martin, & Forrest

E. faecalis


Tetracycline: Binds with 30S bacterial ribosomal subunit &

interferes with protein synthesis. Erythromycin & Clindamycin

are the same but they bind to the 50S subunit

3-4 years



Walton (1992); No bacteria found in apical granuloma

(Doyle & Miller 1981 also against anachoresis)


Originally believed to be Clindamycin, but can be any

Antibiotic (except vancomycin & metranidazole)
1. Inferior to the mandibular 2nd bicuspid, 2. 60% of the

distance from the buccal cusp tip to the inferior border of

the mandible, 3. It exits superiorly & posteriorly

Torabinejad: It is a continuous immune reaction to antigens.

The immune reaction is responsible for the proliferation of


Allison & Walton (1981)

IL-1, IL-2, IL-6, TNF-

Woven, Lamellar, & Bundle
Gram+ & Gram- strict anaerobes

MB root of Max 2nd molar (Torabinejad 1992)

Continuous growth of epithelial cells removes central cells

from nutrition; innermost cells die & cyst cavity forms

Vertical Compaction


Bell’s Palsy
Facultative Organisms


Yes; Perrini

Canadian Balsam

Yeast (Nair 1990)

Candida (Waltimo)

E. faecalis (Sundqvist 1998)


All 3 are bacteriostatic



Morgan & Montgomery

Robinson 1941 (cavity preps in cats w/ bact injections)

Gier  bacteria are attached to inflamed pulps

Tziafas 1989 (repeated Robinson’s experiment w/ dogs-used

CaOH to promote inflammation

4,000-10,000 WBC/mm3

No because mammalian cells have no cell wall

Hudson, Gold, 1862

Yes, T cells are in greater quantity



Gangrenous pulps could act as centers of infection causing

alveolar abscesses


Price (1901)

Legumes, from leaving a tooth open

1.Heat causes inward fluid mvmnt, 2.Cold causes outward fluid

Mvmnt 3.Concurrent distortion of odontoblastic processes

stimulates nerves at pulpo-dentinal jxn 4.Distortion leads to

impulse conduction

PenVK (85%)—1st Choice, Amoxicillin (91%), Amox/Clavulinic

Acid (100%), Metranidazole (45%) – only effective against

anaerobes, Clindamycin (96%) – great for pts allergic to PenVK

Elmer Jasper 1930

Glick & Trope

1. Di- & Tri-calcium silicates, 2. Tricalcium aluminate, 3. Bismuth

Oxide, 4. Tetra-calcium aluminoferrite (Not in white MTA),

5. CaSulfate Hydrate

Hammerstrom 1997

Metastatic Carcinoma
CHX (also previously recognized that NaOCl was, & that they

were equally effective)

12% (Safavi 1996)

Yes, but apical resorption does occur more often, so be

cautioned (Hines 1970)
Regardless of technique NONE left a continuous layer of sealer

between the GP & the wall

Inc AP actually occurred due to bacteria b/c missing phagocytic

leukocytes couldn’t help to minimize AP via protection against

microorgs i.e. host defense regulate the development of AP

Lower Lip

Prevents x-linking of murein in inner portion of wall  cell

bursts in hypotonic environment (Bactericidal)
15% & 3%


3 months

They are increased

WD Miller 1890
Inc lithium concentrations

Harry B. Johnston 1928

Macrophages (24%), Lymphocytes (16%), Plasma Cells (7%)

PMNs (4%), Fibroblasts (42%), Epithelial Cells (5%)

Vascular Cells (6%)



William Hunter 1918

69  97 BPM

Gutta Percha (Patented by Hall in 1847)

90% for non-perforating & 25% for perforating

Tx: CaOH for 1 week & WV obturation

Hatton 1922

1. Stimulation of platelet adhesion, aggregation, & release

2. Activation of factor 8 (Hageman) & other clotting factors

3. Mechanical Tamponade, 4. Release of Serotonin (5-HT)

‘Sun Ray’
Weakens dentin (Cvek)

No difference (only a 3 mo comparison) Cooper IEJ 1993

Mattison 1983
Ram 1977 (#40)

Salzgeber & Brilliant 1977 (#30)

Abou-Rass 1982: Fluid doesn’t go much past the bevel tip
E. faecalis only in 12% (it wasn’t the primary bacteria found)

This challenges current beliefs 1st study not to find sig

E. faecalis inhabitance

Smear layer removal (with either MTAD or EDTA  both

removed the smear layer equally well)
The seal of the tooth

Raynaud’s dz could cause necrosis of pulps b/c of the affect on

the terminal circulation (Rankin JOE 2007 Feb)
9-18 mo (Cvek 18 mo) (Yates 9 mo) (Kleiner 12 mo)

Cervical (Nerwich & Messer 1993)

Surgical Enucleation (Burg 1982)
Inc heart rate & cardiac output

In the morning before latex dust is stirred up in the air.

Moos (1996) Pulpectomy alone provided better post-obt relief

Reader: Trephination did NOT significantly reduce pain

1.Periapex closes w/ definite recession of canal 2.Obliterated

apex develops w/out any changes in canal space 3.No radio-

graphic evidence of development in canal or apex; an apical stop

is evident clinically 4.Calcific bridge forms coronal to apex that is

detectable radiographically

B Cells (Stashenko 2000)

Undermining Technique (Allows CT & epithelium to remain

attached to the root surface after reflection)

Antihistamines (0.5% Neosynephrine)

Wilhelm Roentgen 1896

In a gradient slight cervical, moderate in the middle third, &

severe in the apical 1/3 (possibly b/c pulp dies corono-apically)

Stropko Air Syringe (10% of standard pressure)

Trowbridge & Franks (1980)

No; crestal levels are also reduced following sx

Formaldehyde & Resorcinol (polymerize when 10% NaOH is

added) Schwandt JOE 2003
True (Valderhaug 1997)

PDL (the pulp is NOT needed) Mechanowitz & Abou-Rass (1971)

Chloroform was the best

24 hours

No; didn’t improve osseous repair (Torabinejad 1997)

6% NaOCl alone (Pashley, et al JOE 2007 Feb)

Complete radiographic healing in 81% (1 visit) vs 71% (2 visits)

Although, this was NOT found to be statistically significant in

this study.

Hydroxyl ions diffuse through dentin (1-7 days elapse b4 pH

begins to rise in outer dentin—apically 2-3 weeks delay). Inc in

pH may be mechanism for stopping resorption (Nerwich 1993)

10 (mixed) & 12.5 (set)

2-3 Weeks (inner dentin peaks at 1 day)

Nerwich & Messer 1993
1. Devitalization of adjacent teeth, 2. Damage to anatomic

structures (IAN, sinus), 3. Loss of bony support, 4. Paresthesia,

5. Elderly patients where sx is risky

Inc systolic & dec diastolic BP

P= Perf, O=Obturation, O=Overfill, R=Root canal missed

P=Perio dz, A=Another tooth, S= Split, T= Trauma

NO; degree of coronal mobility=significant factor

Al Frank

Yes; but the CDJ width does not (Stein 1990) – Another study

on why we fill .5-1mm short of the radiographic apex

1. Clotting/Inflammation, 2. Epithelial Healing, 3. CT Healing,

4. Maturation/Remodeling

NSAIDs &…EtOH (Possible GI bldg), Antihypertensives (for

more than 4 days), Digoxin (NSAIDs can dec PG production in

kidney= dec metabolism & inc bld concentrations of digoxin),

Lithium, Anticoagulants (GI bldg), Methotrexate (avoid if high

doses 4 cancer-low doses 4 arthritis are okay)


Barrier between pulp chamber & endo filling (West 1994)

Resorcinol-Formaldehyde Resin


No, but all foreign objects must be removed for resolution of

the lesion to occur

Air Vapors

Caplan 2002

100% Epithelial Lining & Cholesterol Crystals

Natkin (1974)

48-72 hrs; responsible for fibroblast activation

Velvart 2002

NaOCl (5.25%)

Neagley 1969 & Madison 1984

Mod-Severe pulpitis or necrosis

Wilcox 1991
Density & # decrease, and the thickness increases (Thus more

apical resorption occurs, b/c less fibers = less protected ) Aujeung

& Polson 1988
1. Take vertical PA 2. Triangular flap w/ VRI on distal (Although

rec by Moisewitch 1995-Not rec b/c of cutting Facial Artery)

3. Make groove in bone superior to foramen to prevent retractor


Triazolam 0.25mg

Parallel & cemented, not screwed

3% (Also by Marbach 1978)


Kim & Takehashi (also found sympathetic adrenergic

vasoconstrictor fibers)

Waplington, Lumley & Walmsley (1997)
Karl Koller (1884)

No; all post types leak (Kazemi)

1. A. israelli, 2. Cysts, 3. Foreign Body Rxn (small pieces of GP),

4. Propionibacterium propionicum, 5. Infected dentinal chips

pushed out the apex, 6. Bacterial plaque over the cementum


Pulp stones are calcifications & dentricles are composed of

CHX gluconate (safe!); reduced by 78% after 10 days

Nygard-Ostby 1957

Immediate Post Space Prep

Breakdown products of tissues


60 days (Hebling 1999)

ZOE; it absorbs at nearly the same rate as dentin. Coll &

Sadrian 1996  78% success, better when <1 mm resorption

Ketorolac (3 mg) & Dexamethasone (0.4mg)

2/3, 10-15mm, 4-5mm

~50% of the time (only in cases as needed- specifically

btg/pre-op perc) Creech & Walton 1984


ASA enhances insulin secretion & reduces blood glucose

levels; can inc hypoglycemic effect

Yes; less leakage occurs. Metzger 2000, Wu 1998,

Sato 2002, Fox 1997

1. Subepithelial External Resorption 2. Invasive Cervical

Resorption 3. Extracanal Invasive Resorption 4. Periodontal

Infection Resorption


Lamina Limitans (Organic structures)

Frank, Antrum & Bakland (1996)

Alfred Einhorn 1905

Heated plugger technique showed less leakage at the 3 &

5mm levels (Mattison 1990)  Todd 1983 showed NSD
1. Presence of systematic dz

2. Use of intracanal medications

3. Penetrating foramen w/ small instruments (finding WL)

1. <15min out of socket, 2. Don’t touch the root, 3. Keep moist,

4. Minimal splinting (Koenig)
Tonder; localized inc tissue pressure may persist in inflamed

area w/o circumferential spread to rest of pulp (neg feedback


Isobutyl Cyanoacrylate

Coolidge 1919

No (Quesnell JOE 2005)

1. Age, 2. Sex, 3. Pre-op pain, 4. Allergies, 5. Absence of

PARL, 6. Sinus Tracts, 7. Re-Tx Cases, 8. Those receiving

Rx analgesics (Torabinejad 1988)


7 days (Hebling 1999)

93% Success

Clindamycin (bone can retain 30% of clindamycin in serum)

47.6% (Inc pain noted with extrusion of sealer or GP)

Facio-lingual direction

Chloropercha (overfill) & Formocresol (Pulpotomy)


Premolar/Molar teeth only & very strict criteria (44%)

Pressure (Rosenberg 1975)

Yes; Nemetz 1992

No; Hagger 2002, Walker 1998, Schindler 2001
Hydroxyl radicals are generated after thermocatalytic bleaching

with 30% H2O2; may be one mechanism of PDL breakdown

N2, followed by CRCS, & then Sealapex


Lower Lip

1. Gow Gates (longer onset: 5-10 min vs 3-5 for IANB)

2. Akinosi (Lower aspiration rate; good for bifid alveolar nerve)

3. Incisive nerve block (Mental foramen)



AH Plus (also had the greatest film thickness); Roth’s 801 never

set during this experiment
Macrophages (TenCate 1992)

Hepatitis B


Infolding of the dental papilla during development

First 6 months

No inflammation was seen & cementum was deposited over the

Fibroblasts & Macrophages


1. Cementum forms over MTA w/ Sharpey’s fibers, 2. (-)

Mutagenicity tests, 3. Osteoblasts grow in contact w/ MTA,

4. inc levels of cytokines from MTA-osteoblast cultures (IL-

alpha, IL-beta, IL-6) Torabinejad 1995 & Koh & Forb 1999

<2.5lbs (Hicks 1989, found 2.2-10.8lbs)


20`C inc (4`C all will recover, 10`C 85% will recover, >20`C

all become necrotic)

sEBA (95%), IRM (91%), Amalgam (75%)
Prednisone & Diphenylhydramine (Kleier JOE 1999)

No; x-rays (Priebe & Lazansky 1954), Yes; CT (Trope 1989)

30% H2O2 with heat (Madison & Walton JOE 1990); Resorp-

tion occurs when heat is used by driving superoxol through

the dentinal tubules thereby directly altering the cementum

No; Olsson (2005) showed no bridge formation &


Closed mouth mandibular block

Vazirani-Akinosi block
Cast Posts


NiTi; less force & more distributed than SS (Schmidt 2000);

can also penetrate deeper.

To deposit collagen & mineralize it (TenCate 1992)

Gauchers (Lipid Metabolism Dz)

Zinc Eugenolate (eugenol can cause extensive tissue damage)

Kim 1992
People of mongoloid ancestory (Senia 1974)

Damage to tooth & damage to periodontium

Hydroxyapatite (Lemon), DFDBA (Hartwell), Gelfoam (Walla,

Hartwell), CaOH (Peterson, Frank, Weine), Collacote

(Rosenberg), Calc Phos (Chau), Calc Sulf (Alhadainey)


Mandible (Especially Posterior)

Dryden (JOE 1975)

A: No pathosis (Tx w/ prophylactic measures: sealants/comp)

B: Pathosis (Requires pulpal therapeutic intervention)

Rotstein, et al. 1987

Oikarinen 1987

Simon (1986)


Yes, considerable fibrosis

Initially: Palpitations, Inc Heart Rate, Elevated BP

Secondarily (Severe): Arrhythmias, Stroke, MI

1-2% (Senia 1974)

Older average age (Closed apices)

Alternating heating & quenching; immerse in hot water (>55`C)

then remove & immed immerse in cold tap water or alcohol for

several seconds (Sorin 1979)

IL-1Stashenko 1990

Yes, via disrupted blood flow (Todd & Langeland 1987)
Yes, Titley & Torneck 1993

Torabinejad (1993), Trope (1995), Alves (1998)

Decompression (Rees 1997 & Freedland 1970)

In the refrigerator at high humidity (Kolokuris 1992)

1% (Garberoglio & Brannstrom 1976)

The Erbium:YAG laser worked sig better to decrease



Molven: most increased widths favor healing in the long term

True (Baumgartner 1984)

The gonan system

Al Nazhan

PBI (.07mm, .10mm, & -.06mm at 1,3, & 12 mo) vs. 1.1mm,

1.25mm, and .98 mm for full papilla elevation (Velvert 2004)

Trismus & Inability to see landmarks for IANB (Lg Tongue)

At jxn of cusp & lingual surface, there is developmental groove

which creates a lg niche to harbor bacteria (Rec prophylactic

restorations be done) Mellor & Ripa 1970

3% Concussion, 6% Subluxation, 26% Extrusion, 58% Lateral

Luxation, 85% Intrusion
Within 1-2mm of the working length (Walton 1981)

Generic term for non-antibody protein (i.e. lymphokine)

released by certain cells on contact w/ a specific antigen.

Intercellular mediator: helps generate immune response.

Multiple PARLs, even on virgin teeth

O2, Epi pen, Nitro, Injectable antihistamine/diphenyhydramine

or chloropheniramine), albuterol, aspirin, oral carbs,


60.2% of the time (if aberration was rare- less than 1%

prevalence- it was bilateral 90% of the time)

Fibrous dysplasia

Did not prevent healing & the body removed it from the apical

1. Modify behavior of other cells

2. Produce systemic effects

3. Act as growth factors

Blood supply to mucosa is by vertical blood vessels

(Kindlova 1965)

Asthma-like signs of tachypnea, wheezing, bronchospasm,

dyspnea, tachycardia, dizziness, weakness, severe flushing,

general urticaria

Coronal Anomaly of pre-molar teeth (Senia 1974)

Granulomas (Delzangles 1989)

Needle sleeve technique, Endo extractor, Braiding Hedstroms,

Masserann Kit, Ultrasonics, Gonon Post Remover

30-60% in perio abscesses & only 0-10% in endo abscesses

Trope 1988

Pashley 1983: Dog study claimed systemic spread is possible

Ranly 1987: Resp distress, lacrimation, death (if enough is

Used-had to use 125x normal dose, though) Sipes 1986:

Tissue dmg.

30 days (after 180 days a difference was shown-CaOH sig

weakened the root dentin)


B or C: Sae-Lim (2004) showed NSD btwn PDLs with or w/o

Clockwise (Sutter JOE 1998)

T Cells (Stashenko 1992)


First introduced by Marsh in a congress report (Reintroduced

in 1961 by Spasser)
1. Absence of symptoms, 2. Absence of swellings, sinus tracts,

or signs of infections, 3. Radiographic evidence of healing,

4. Continued normal functioning of the tooth

Gartner & Mack

1. Time: imm repair= better (Seltzer 1970)

2. Location relative to attachment (the more attachment coronal

to the perf the better) Contamination w/ oral fluids=Failure (Jew)

3. Size: Smaller is better (Jew 1982)

4. Sealability of repair material (MTA now the best-Torabinejad)

Proposed as possible mechanism of focal infection: LPS (from

oral bacteria) down regulates E-selectin expression in vasc endo-

thelium-leads to dec leukocyte diapedesis at distant sites of infxn

35% Phosphoric Acid soltn; triple Ab mix: cipro, metro, &

minocycline in 1:3:3 ratio mixed with sealer or glycol as a carrier

No; hemostasis was also effective in ALL cases

Apex Locators

By RC infection coronal to the site of the lesion

Actual torque reached was significantly higher than advertised in

EVERY case could lead to instrument fracture
1) Inc platelet adhesion aggregation, 2) Activates Hageman

factor 8, 3) Forms mechanical plug of collagen, 4) Evokes

release of 5-HT --Minimal tissue reaction (good 4 hemophiliacs)

Spray technique b/c it sticks to surfaces

Yared, et al.

Al-Sabek, Shostad, Krikwood (JOE 2005 Mar)

Facultative anaerobes can grow much more rapidly w/ O2;

opening a tooth gives them fuel to grow


It increases SP levels (may be significant in inflammation & pain)

Interferes w/ healing & does not resorb; causes foreign body


Liquid; esp w/ U-type flute designs. Theory is that pastes cause

more dentin debris to get lodged in the flutes while liquids wash

them away


Endo paper points or cotton wool (cellulose containing products)

ALL instruments showed topographic irregularities distributed on

the surfaces
It induces its production by activating the NO Synthase (NOS)

By slowing infiltration of CT components into the wound site &

allowing time for osteogenesis to occur

3 min; b/c theorized that longer time periods will saturate

irrigant w/ minerals that will precipitate & occlude tubules
It has been shown to increase it (Moshonov, et al.

JOE 2005 Mar)

Extracanal Invasive Resorption

Less inflammation (None as Torabinejad claimed) & more

homogeneous hard tissue/dentin bridge formation
Believed to be similar to CaOH; Calcite crystals attract

fibronectin, which is responsible for cellular adhesion &

differentiation (Holland 2001)

B/c most vessels run parallel to the long axis of the teeth

(MacPhee & Cowley 1981)

1 receptor

80.8% (95.2% in M root of Mand 1st molars)


AH Plus & Grossman’s  Good argument for 1 visit since they

were more effective than CaOH
No; activates intrinsic & extrinsic clotting pathways

(do not inject systemically)

Microfibrillar bovine collagen
Vascular, platelet & coagulation phases

83%, 53%, or 29% respectively (all were non-lesioned irr pulpitis

cases to begin with 1-5 yr recalls)
1. Walton 1993(does NO good in necrotic teeth)

2. Walton & Fouad(No good in dec post-op pain or flare-ups)

3. Reader 2000/2001(NO good in dec post-op pain, perc,swllg)

4. Chiapinelli

MMP-9 (Tsai, et al. JOE 2005 Dec)

Yes; keep on normal coumadin regimen & use local tranexemic

acid (a potent anti-fibrillar agent) post-op for 2 days

(Souto & Oliver 1996)

Aqueous (JOE 2007 Mar)

1. Giant cell hyaline angiopathy

2. Vegetable granuloma

3. Food-Induced granuloma

Sluyk & Hartwell (moisture probably derived from furcal


1. Signals for morphogenesis

2. Stem cells for responding to the morphogens

3. Scaffold of extracellular matrix (Nakashima JOE 2005 Oct)

Hartwell 2002: Human study in vivo (found NSD)

Torabinejad 1998: Cat study-GTR caused inflammation

No; passing files through the NaOCl in the canals was enough

to disinfect it
After 1 week delay; Seal done immediately after bleaching was

weaker. Non-vital bleaching w/ carb peroxide adversely affected

the immed sealing ability of comp restoration (Turkun 2004)

Anterior area (Borg 1974)

It’s biodegradability by bacterial & salivary enzymes
1. Through & through PA lesion

2. Large PA lesion

3. Endo-Perio lesion: PA lesion communicating w/ alveolar crest

Furcation involvement as a result of perforation

Root perf w/ bone loss to alveolar crest

1% & 2% CHX (.5% NaOCl took 30 min, 2.5% NaOCl took 10

min, 5.25% NaOCl too 15 secs)

A True Periapical Cyst

Baek, Plenk, Kim (JOE 2005 Jun)

In 1981 Torabinejad concluded that endotoxin can cause severe

pulpal/PA inflammation; Horiba(1991), Schein & Schindler(1975)

both found correlation btwn endotoxin levels & nec symp teeth


97%, 85% (This included GP’s doing RCTs) Salerhabi 2004

Cell rests of Malassez

Eleazer 2001

Exponential Growth Phase (stationary, less so, Starvation =

resistant to medicaments (Waltimo, Orstavik, Haapasalo

JOE 2005 May)

Bleeding (even possible during NSRCT), as in coumadin patients

NaOCl, H2O2

EndoIce performed best in all situations (7-8`C dec in virgin tooth,

PFM, or all ceramic crown-FGC about 15`C dec)
Yes: Torneck 1982; Holan 1992

No: Andreasen 1978; but his study was short term on monkeys

Leakage of Zinc ions to fluids (Spangberg 1990)
1. Torneck 1967: Polyethylene tubes (sterile empty= best prog)

2. Goldman 1965: Teflon rods (Interchange of fluids occurred)

3. Wenger 1978: Polyethylene tubes obt flush at one end & 1mm

short at other (No inflam response to tubes, Grossman’s or GP)

Partial Thromboplastin Time (Intrinsic)

1. Marshall: IP/AP, IM Dexamethasone

2. Reader 2000: I.O. 40mg methylprednisone(Depo-Medrol)

3. Morse 1989: Oral dose reduced pain at 8, 24, & 48 hrs

‘5 yr survival rate’= 98% endodontists, 90% GP’s (vs. implants

at 95% “success rate for 5 yr survival”)

52-68% (Shear 1992; Killey 1977)
Tay, et al.
Statistically sig differences in bacteria found in Portland &

Brazil (Siquiera 2004)  geography plays a role b/c of host

factors, genetics, quality of food/water, stress, climate, etc.

Al-Sabek, Shostad, Kirkwood (JOE 2005 Mar)

1. Torabinejad 1994

2. Morse 1987: (20%  2%)

Roth’s 801

11.5 pH & up

Protein gel that has been shown to promote acellular cementum

formation (1st step in regeneration of attachment apparatus)

NaOCl is much better, electrochemically activated water is

NOT an ideal irrigating solution

Composite “backfill”

Premolar area (Borg 1974)

1. Calcium Sulfate, 2. Glycol Acetate, 3. Triethanolamine,

4. Polyvinyl acetate, 5. Polyvinyl chloride acetate,

6. Red pigment

E. faecalis down regulates alpha 4 integrin expression which

would prevent (slow) PMN’s recruiting abilities
Vit K dependant factors

Nabumetone (NSAID): Dec PG release from intrusive forces

Grey, 5mm, 2 step (at least when comparing leakage)

Stratified Squamos Epithelium (Sometimes: Ciliated Columnar

1. Confer ‘stickiness’ to dentin

2. Reduce ZnO solubility

3. Exert antimicrobial effects (Sunzei 1990)

Sjogren & Sundqvist 1998

44 hours


Night & day one of surgery


Acoustic Streaming (thus its only good for large, straight canals)

Pitt Ford 1987

Symptomatic Teeth

Impaired phagocytosis, chemotaxis, adherence, & killing of

bacteria. Decreased collagen synthesis, dec capillary in growth, &

decreased fibroblast proliferation


5% (Walton 1988)

Only macrophages (Torabinejad)

Hutter (1999), Reader (1992), Cunningham (1982)

C3: Histamine release

A Disodium salt solution that collects Ca++ ions & replaces them

with Na making the dentin softer

Mandible 91% vs 67% (Maxilla)

Vital pulp, normally asymptomatic

15 seconds

C5: Chemotactic for granulocytic cells

Efficiency of vascularization & platelet phases of coagulation

2% lido w/ 1:100k epi

4% art w/ 1:100k epi
6.5k ohms=constant value

15 minutes

1. Al2O3

2. MgO

3. FeO (Asgary, et al. JOE 2005 Feb)

Strep pyogenes infection (redness & swelling)

Prothrombin Time; extrinsic (Want at least 150% control values)

Measures 5,7,10, prothrombin, fibrinogen

Yes; microhardness is a way to determine change in dentinal

Ca/P ratio
Females & younger patients

Pre-Op Pain

US energizes irrigating solution by cavitation
1. Vital tissue in tooth (at least some) Delivanis 1984

2. Inflammation (Robinson 1941)

3. Bacteria (IV injxn & traumatic pulps Gier & Mitchell 1968)

Tziafas demonstrated accumulated bacteria under CaOH pulp

caps after IV injections
At least 150% of control values

3.8% EDTA, Urea Peroxide, Propylene Glycol

Anterior Maxilla

1-3% of Patients (Imura 1995, Walton 1992)

Induced proliferation (Moghaddame, et al.)

Vasorelaxation  Leads to more bleeding

150-400k/ml; for surgery at least 50k/ml

Spontaneous bleeding at <15k/ml




Gutarts, Nusstein, Reader & Beck

C6: Bone resorption

7, 10, & prothrombin

5.25% NaOCl

Suzuki 1942

May act as chemotactic agent for resorptive cells (making

root surface more prone to resorption & ankylosis)

Zervas 1991

TGF-1 & BMP-2

Guven, et al. JOE 2007 Apr
C9: Cell lysis & triggering of cascade (self-perpetuates)

PT (Prothrombin Time)

No: Hasselgren 1989, Trope 1990: Tested formo, ledermix, CaOH

Walton 1977: Tested formo, phenolics, & CaOH

Kobayahi (Root ZX measures impedence at 8 & 0.4kHz &

calculates a quotient of impedence) -- Dual Frequency

A dec frequency of microorgs in the pulpal lumen & less

ankylosis or inflammation as a result of the soaking

1. Direct extension (fascial planes), 2. Hematogenous (via facial,

angular, ophthalmic, or cavernous sinus), 3. Local lymphatics,

4. Indirectly by extraoral infections (1` Streptococci, Bacteroides,

Staph) Tronstad 1999

Suanders & Gutmann 1994 -- But may have been due to setting

power at 10

Inorganic Dentin Component

90% (Baumgartner): accurately locates minor diameter

96% (Shabahang): within .5mm of apical foramen
The more open the apex, the > success of the revascularization

(>4mm=33%, >1mm=18%)-- When soaked in doxycycline &

shrtr out of socket times: Cvek & Cleaton-Jones 1990 Mnky stdy

Silicone based RC filling material

Er-YAG Laser (Takeda 1998)

1. Power 2. Time 3. Initial Cracks

4. Thickness of dentin

No significant difference found

Smear layer removal improves fluid tight seal of root canal

system, whereas other factors (like obturation or sealer) did not

produce significant effects

Mandibular molars & maxillary premolars

5.25% NaOCl, MTAD, & 2% CHX all worked (1 min immersion)

No (Gwen, et al. JOE 2007 Jan)

Primary: surgical removal or parathyroid

Secondary: Renal dialysis or transplant

No (Reader’s group JOE 2007 Jan)

Laser Doppler (91%) vs. EPT (64%) Ingolfsson & Tronstad

1994 EDT
PA bone loss, widening of the PDL, Associated perio pkts, sinus tracts, bruxism, or a particular pulpal status

Lexicon & Maillefer

VEGF may be released via a Cox-2 dependant pathway

(Guven JOE 2007 Jan)
Diamond coated (but these also broke the most often)

Lin, et al. JOE 2006 Apr

Chance (1987): Vital Teeth, Morse (1984): Vital Teeth

Pierce (1987): Ledermix-min inflammation assd with root

resorption traumatized teeth, Rogers & Johnson (1999):

Ketorolac 3mg or Dexamethasone 0.4mg

51% & 22%

30 Minutes


Prevotella nigrescens (Baumgartner 1997,1999)

Wuchenich & Torabinejad

Reduces surface tension & increases dentin penetration

Radix Entomolaris



They are involved in calcified tissue formation (without them-

like in the knockout mice-marked anomalies in the dentin

structure are found)

Pulp horns will often extend into the DEJ (Bender & Naidorf

1985) Enlarged chambers, wide canals, loss of lamina dura

Enamel (Dentin less affected, even after 14 days,

Kugel, et al. JOE 2007 Jan)

Radix Paramolaris

Women & older ages

Comparable (Merdad, et al. Friedman JOE 2007 Jan)

Vascular Endothelial Growth Factor; glycoprotein that has the

ability to inc the permeability of blood vessels & to induce


Renal disease, vit D deficiency, or Ca++ malabsorption states

Equivalent (JOE 2006 Nov)

PARL on carious 1st molar. Tooth was asymptomatic & vital;

PARL healed after caries removal & IRM base & amalgam

Periradicular bone loss, Pain to percussion, Extensive


Glass Ionomer

25 microg/ml for 5 minutes (Soukos, et al. JOE 2006 Oct)

It leaked sig less then sEBA & there was NSD btwn MTA & resilon/Epiphany (??????) (Maltezos, JOE 2006 Apr)

Because CaOH in primary teeth can cause Internal Resorption (Kubota 1992)

Mandibular second molar

Neuralgia Inducing Cavitational Osteonecrosis

1. More Ca++ ions released in a 24 hr period, 2. Easier to handle, 3. Need dec amounts of water in mixing process, 4. Improved sealing ability (Bramante’s group JOE 2006 Sep/Dec)

Asaccharolytic BPB: Porphyromonas

Saccharolytic BPB: Prevotella
Adenoma (80%) carcinoma of the parathyroid or PTH release from ectopic malignant tumor


Post-Cement Interface

Older age, Trauma, Traumatic Occlusion (Tulkki, Baisden, McClanahan JOE 2006 Oct)

Significantly decreased them

T Cells, B Cells, Macrophages, PMNs

Sickle Cell Anemia
Higher than Tetraclean, but equivalent to EDTA’s (Giardino, et al. JOE 2006 Nov)
Women, especially those with menopausal or menstrual problems (2x as likely as other women) Hargreaves 2005
Atypical facial pain or Trigeminal Neuralgia

Conventional Root Canal Sealers

No; cell fragments or supernatants can cause inflammatory reactions as well (Stabholz & Sela 1983)
Hirsch 1979

Same; NSD—BouDagher & Yared 1997


Yes, High incidence

AH+ & Epiphany (Tanomaru JOE 2007 Mar)

1. Thin layer on the surface of canal walls (1-2 microns thick)

2. Thicker layer in the dentinal tubules up to 40 microns thick
Luebke 1964

5.25% NaOCl/15% EDTA (although in Jul 2006 he did almost the same study and found them to be equal)

Not necessarily: not measured in absolute units

It makes the root more resistant to resorption & stimulates new formation of PDL from the socket

Polydimethylsiloxane-Based Sealer

Porphyromonas: P. gingivalis, P. endodontalis

Prevotella: P. intermedia, P. malanogenicus

Stones (ectopic calcifications: kidney stones); Bones (lesions-lytic- Brown tumors, CGCG-ground glass appearance); Groans: vague abd pain, fatigue, weakness, psychoses

32 beats per minute

Resin-Based Sealer

Neuralgia Inducing Cavitational Osteonecrosis (NICO) lesion

Coronal 1/3; thus not a great reason to buy the tips! (Al-Hadlaq, et al. JOE 2006 Dec)

1.Defective RBCs: pts are prone to infxn b/c macrophages are busy in phagocytosis of RBCs & aren’t available to destroy the bacteria 2.Occlusion of vessels from bad RBCs

Powdered CaOH (showed excellent removal)

1. Listerine

2. K-Y brand Ultragel

3. Crest Baking Soda & Peroxide Tartar Control Toothpaste

Ischemic Osteonecrosis

Greater wettability = better spreading capacity

Greater bacterial species = greater pain Sundqvist 1976

Sluyk & Hartwell (1998) > at 24 hr vs. 48 hr

Twice as much blood loss w/ 1:100k epi

(Buckley & Ciancio 1984)
No (Glick 2005)  Neither have Airscalers, US, Electrosurge, EPT, Curing Lights, or Diagnodents
Decorticate & curettage

~810 nm (daCosta Ribiero JOE 2007 Mar)

McComb & Smith 1975

sEBA 95%, IRM 91%, Amalgam 75%, Apical Sx Alone=59%, Retreatment w/ Apical Sx=80%

Horner’s syndrome

Dry canal group (CaOH didn’t fare as well as expected, either more or = growth to single visit)
Possible subtle radiographs; maybe history of trauma, EXT or infection

Makes it better (less apical leakage occurs-Gunday 1993)

2-4 Weeks
Triazolam (.25mg); Dionne 1993, 1997

Not very accurate b/c nerve endings degenerate w/ onset of root resorption & predisposes the tooth to false negatives

1. Open: Loosen w/ forceps & allow to spontaneously erupt

Closed: Ortho repositioning is preferred (do by 3 weeks)

2. RCT at 3 weeks

.04=58% reduction in dentin debris, .06=83% reduction, .08=94% reduction  significant difference btwn .04 & .06 (taper matters!)

Reduced with denervation (Fristad 1995)

48-96 hours


Penick 1961

Bhaskar 1966

Lalonde & Leubke 1968


Low (.8-1.6pH); evokes intravascular coagulation (similar to cautery) need to irrigate out when done (curettage, too) Jeansonne & Lemon 1993

Juvenile onset; against the beta cells of the pancreas

Rivera & Walton 1996

1 year

Granuloma, Cyst, OKC, Ameloblastoma, Sarcoma, Nasopalatine duct cyst, Globulomaxillary Cyst (vital teeth), Adenomatoid Odontogenic Tumor


IL-1, IL-1, IL-6

Type 2

Diploplia (36%)

No (interfacial gaps still present)

Pirani (Tay) et, al. JOE 2005 Dec

Hyperparathyroidism, Leukemia, Scleroderma, Pagets, Cushings, VitD Resistant Rickets, Osteoporosis, Gauchers
45 min (showed no differences from glass ionomer placed 4 hrs later, in setting reaction & or in formed calcium salts)
Inorganic/organic debris (pulp, bacteria & bacterial byproducts) Sen 1995
No (Nevins 1994)  Prophylactic benedryl plays little or no role in abating post-op pain after cleaning & shaping
3rd decade, men (Shear 1992)

Reposition & physiologic splint 2-3 weeks, adjust occlusion

Complete RCT if no response to vitality testing in 3 weeks (with closed apex), if open: F/U often to rule out necrosis

3 min (vs 7 min syringe irrigation); % of debris removal was much greater with US (80-90% vs. 25-50%)

1. Torabinejad 2002; Dec bacteria & improve adaptation of obt materials, 2. Yang 2002; Can help prevent canal reinfection, 3. Gunday 1993; Holz, Jeansonne, &Taylor 1997

4. White 1987; Better adaptation of filling materials

3-8 days
Not very Loses about 90% of it effectiveness in the 1st 24hrs (Cleared only 67% of RC system from bacteria vs. 97% by 1 month w/ CaOH) (Messer 1984)

2 visit with CaOH for at least one week

Nair 1996, Rubenstein & Kim 1998


Inhibition of plasminogen activation

Type 1

CaOH inhibits macrophage adherence (Segura 1997); Osteoclastic cells (osteoclasts & PMNs) prefer acidity - High pH of CaOH antagonizes their action (McCormick 1983)

Disruption & change in the sizes of the PDL space & bone trabeculation (similar to report by Brynholf)

Muscle Attachments

Causes root fractures


15% of all diabetes mellitus cases

Bacteriocidal (Foster 1993)

Transient increase in apical radiolucency occurred over 1st few weeks after NSRCT

Granuloma, Cyst, OKC, Sarcoma, Ameloblastoma

That teeth fully cleaned & then had broken instrument = NSD in leakage (both leaked at 45 days)

IL-1 & , TNF-& , PG’s

CHX (Santos, et al. JOE 2006 Nov)

NSD (91.8% success w/ instruments, 94.5% w/o) What really mattered was a lesion (86.7% vs. 92.9%) Crump & Natkin: 153/277 didn’t return -> Would it affect outcome? Also didn’t know where instruments were broken at


White; Al-Hezaini, et al JOE 2006 Nov -- Also found the same for killing Candida (JOE 2006 Apr)

Variations in anatomy, Acute tachyphylaxis, pH: inflam (on tissues), Vasodilation: inflam (on blood flow), Allodynia: inflam (on nociceptors), inflam effects on central sensitization, psychological factors

1. Pre-existing AP was a large predictor of the outcomes:

w/o PARL: 91% Healing, w/ PARL: 71% Healing

2. There was stat sig dif btwn outcomes of those tx’d w/ WV & a taper vs. cold lateral & step-back (10% better with WV)

How quickly & well teeth were stabilized (splinted)

No (Iqbal, et al. JOE 2006 Nov)

Gram + cocci & Gram - rods

“Stepladder” appearance of the widening trabeculation due to inc marrow space (inc hematopoiesis); inc marrow space is accompanied by thinning of cortical plate & irregularities in density

B/c NaOCl causes oxidation of MTAD (like peroxidation of tetracyclines by reactive oxygen species) Tay, et al. JOE 2006 Oct

81% (93% were asymptomatic & fully functional at 4-6 yr FU) (radiographically not healed)
Low fat (Walker)

AH +

Filifactor alocis, Tannarella forsythia, Treponema denticola
No (Baumgartner)

CaOH inactivates LPS in-vitro (also by Trope 1997)

MB root of max 2nd molars (DB root 100% of the time)

Granuloma, Cyst, OKC, Ameloblastoma, Sarcoma, CGCG, Sublingual salivary gland depression (vital incisors), PA cemental dysplasia, Lateral periodontal cyst

BAG draws Ca++ & P from dentin & causes a precipitate to form on the bacteria; this causes a breakdown in the “mineralized” bacterial cell wall (Waltimo 2004)

Eosinophilic granuloma

Gradual adult onset; impaired insulin function (similar to fasting state)


Formalin 10% (in Sept 2006 they showed apical leakage might be sig dec from the control group.

Granuloma, Cyst, OKC, Ameloblastoma (most common in mand molar area), Sarcoma, CEOT (Pindborg- usually next to unerrupted tooth-can be max or mand), metastatic tumor, SCC, Submand saliv gland depression (rarely PA site)


They described the body’s way of isolating & localizing an infection in the periradicular area (against Hunter from 1918)

NSD; 92% ferric sulfate, 84% formocresol
Antimicrobial effectiveness is due to concentration of OH- ions & time of exposure

Friedman (2003)

All of them can

No (Iqbal, et al. JOE 2006 Nov)

Newton, Griffee/Patterson (B. melanogenicus), Hahn, Gomes, Yamasaki (Eubacterium-> acute/chronic symptoms; pepto, P. gingivalis assd w/ subacute symptoms)

CaOH (31-100%), Formocresol (55-98%), Glutaraldehyde(82-98%)

2.5% NaOCl alone is NOT enough to remove the smear layer (& it didn’t matter whether it was hand or engine driven technique)

92% (with 97% functional)

Only 13% success after 10 years  all of which showed calcific metamorphosis

AH + (Maillefer-Dentsply), Epiphany (Pentron), GuttaFlow, Coltene-Whaledent
222 J/cm2
Acts mechanically via tamponade effect, foreign body reaction may occur if left in site

Presence of a smear layer delayed, but didn’t prevent, antimicrobial effects of medications

More successful (82% vs 67% -- may be treatment resistant cases)
6 hours (Blomlof 1980 & Trope 1992) pH & osmolarity are compatible
High b/c it doesn’t allow auto reverse to kick in (Berutti 2004)


Goerig: Slower rate of healing

Bender (2003): more prone to infxn

Fouad (2003): Pre-op lesion & hx of diabetes = sig dec chances of successful outcome of endo tx

NO: Madison & Krell (1984) & Evans & Simon (1986) -- sealer is much more important

YES: Glickman (1995), Economides (1999)

Pre-Op lesion size & root filling length

Hypotonic  causes cell lysis

Methacrylate based root canal sealer

1 Day, 2 Days

IRM & MTA (completely inhibited P. aeruginosa & both delayed or limited growth of E. faecalis)

Vasoconstriction (pulpal bld flow is dec - - don’t use for operative dentistry: Kim 1986)
<5mm=86%, >5mm=65%

Osteoclast resistant: delays replacement resorp = 2x the survival time can be expected (Coccia 1980); Delays remodel of root into bone (replacement resorp) Klinge 1989

Bioactive (Sarkar 2005)

22% (Garberoglio & Brannstrom 1976)

Delays resorption time

2% lido w/ 1:100k epi (Reader 1988)

NSD(84% with orthograde retx, 94% with retrograde retreatment healing rate) Zuolo, et al. found 90% success for sx cases prev retx)

1. Tetracycline 500mg QID x 7days (static-acts on ribosomes) 2. PenVK QID x 7days: use only if Tetracycline is contraindicated (<9 y.o. or pregnant) Sae-Lim & Trope 1998


Bernick 1977

Type III: Reticular type
Substantivity (White 1997)
50% (86% healed w/ AP & w/o perf, 36% w/ AP & w/ perf)
~2 hours (Blomlof 1980)
No (Waltimo 2004)
30 days with PenVK
1. Prone to bact/opportunistic infxns, 2. generalized circulatory disorder, 3. bld vessels damaged by accumulation of atheromatous deposits, 4. capillaries have thick bsmt membrane, 5. impaired leukocytic response capability, 6. dec PMN microbicidal ability, 7. failure to deliver the humoral & cellular components of the humoral system, 8. due to limited pulpal circulation, more prone to infxn

Significantly reduced inflammatory resorption vs. controls

74% (91% of the teeth were asymptomatic & functional)

HBSS=Viapsan, Milk, Saline, Saliva, Water

Ketac-Endo, Kerr Tubliseal (Nielsen, et al. JOE 2006 Feb)


Cotton impregnated w/ Racemic epi (immediate vasoconxn & little systemic absorption. Place on bone w/ another cotton pellet & apply pressure for 2-4 minutes-Kim 1997)

Citric Acid (50% x 2min; pH= 1)

Pre-op perforation, Root filling quality, post-op restoration, pre-op AP (least detrimental)
Cvek & Andreasen 2001: Found splinting wasn’t as beneficial as they thought
Hydroxyapatite (Sarkar 2005)
Proposed peptidergic afferents innervating tubules respond to trauma w/ axonal reflex leading to vasodilation which leads to inc tissue pressure which leads to an outward protective flow of dentinal fluid

36 hours

20 minutes (Reader 1988)

1 step: 3% vs. 8% for 2 steps

It’s antiresorptive & antibacterial; it inhibits osteoclasts & collagenase
1. White has smaller particles

2. White has considerably lower concentrations of FeO, Al2O3, MgO

5-20mmHg(Stenvik 1972)
Tannic Acid
Hosoya 2004

16.6% failure rate for re-tx teeth done in 1 visit (3x the failure rate of those treated in 2 visits)

1. Collagen fibers in PDL make root surface less available to resorbing cells 2. Cementoblasts don’t respond to PTH stimulation like osteoblasts 3. Cementoid covers mineralized cementum

KetacEndo & Resilon (Nielsen, et al. JOE 2006 Feb)

Up to 60mmHg (Stenvik 1972)


Not to leave the canals empty (b/c even after NaOCl rinse bacteria returned within 7 days-CHX had substantivity)
2.2mm mesial & 2.4mm inferior

Transient inflammation (Surface)

Progressive inflammatory

Internal/External (Cervical/Replacement)

1 min: No effect, 5 min: caused severe surface deterioration (Isci, et al. JOE 2006 Oct)
Located in the intraradicular dentin; they are activated by mild self-etching adhesives & may adversely affect the longevity of bonded root canal fillings & posts

Multipurpose Bur

Slow (Kanaa, et al. JOE 2006 Oct) & it’s more comfortable, too

Suda (1998) Germ Free Study

“Pushout Strength” (JOE 2006 Sep)

They heal equally well

1. Calcium Sulfate 2. Gelfoam 3. Collagen 4. Surgicel

More (Maines, et al. JOE 2006 Sep)

RPD (51% survival rate after 60 mo vs 92.7% for FPD)

Wegner, et al JOE 2006 Oct

1. Enamel Fx, 2. Enamel/Dentin Fx, 3. Crown Fx involving the pulp 4. Root Fx, 5. Tooth Luxation 6. Tooth Avulsion
Operator experience

By differentially regulating MMPs which regulate collagen destruction (Wisithphrom, et al. JOE 2006 Sep/Mar)

Promotes platelet disintegration/stimulates thromboplastin release & thrombin formation (animal skin gelatin)

CaOH mixed with CPMC

NSD 1 visit vs. multivisit WRT post-op pain

Gartner & Mack 1976

Varying tapers/varying tips
CAMs are expressed on the vasculature & act to regulate the migration of leukocytes into inflamed tissues (BVs with diagnosis of irr pulp have sig grtr expressions of CD102Cam than BVs in normal pulps) Tasman 1999

As early as 6 days

Equally, but may cause paresthesia-so DON’T use it!

With lesion= 10-30% greater failure rate

1. Loss or alteration of the protective layer (pre-cement/pre-dentin)

2. Inflammation must occur to the unprotected root surface

Roth’s 801 & 811 (Nielsen, et al. JOE 2006 Feb)

Dec in the #’s (Bernick & Nedelman 1975)

Hydroxyapatite, Calcium Sulfate
36% cultivable bacteria w/ CaOH vs. 29% cultivable bacteria w/ IKI
Fuji GI

7 Hours

Humidity significantly inc the pushout strength of MTA obturations (with humidity curing would continue even after initial 3 days- meanwhile increasing pushout strength)

Begins at 4 days, ends around 14 days

2-4 weeks (Biocompatible)

Inactivated LPS (Safavi in 1993 claimed this as well)

Wait a week: delayed cementation shows higher post-dentin interfacial strengths irrespective of post type (Tay’s group JOE 2006 Sep)

12 Weeks (better than 1 week) Trope 1995

.17mm (Walton): statistically sig, but not clinically

No, the bone is deposited directly on devitalized bone

Causes platelet aggregation & fibrin formation-does NOT inhibit healing

Dec apical leakage & allows the sealer to penetrate further (Stevens, et al. JOE 2006 Aug)


Castelli, et al. 1982 OOO

Glyde File Prep dec bond strengths (the other two had no effect)
Lin L, DiFiore, Lin J, Rosenberg

No, inhibits healing & stimulates inflammation (Kim 1997) Not recommended


Bergenholtz 1979

No, but it may delay it

Glide Path

Greater hypersensitivity = greater density & diameter of tubules
Tidmarsch 1989
1. Ribiero 2004 (Formo, PCP, CaOH do NOT promote DNA damage in mammalian cells)

2. Longwill & Marshall 1982 (Formo doesn’t sensitize child)

8mm (useful to consider during post placement)

Photo-oxidation of TTC result in a red-purple TTC degradation product which has a high affinity for Hydroxyapatite (Tay, et al. JOE 2006 Apr)

No (Trope & Orstavik; 1998 & 2000)

Can reduce dentinal hypersensitivity (Brannstrom 1980)


1. Alters enzyme activity (via Hydroxyl ions--free radicals) which destroys the cell membranes

2. Free radicals react with bacterial DNA --inhibition

5%, 20%, 23%

Hard diet (induced less ankylosis)

Resilon (with both methods: rotary & heat, rotary & chloroform)

Quantitative PCR (Sedgley, et al. JOE 2006 Mar) (Zoletti, et al. JOE 2006 Aug) (Williams, et al. JOE 2006 Aug)
Acts mechanically by forming a sticky mass when in contact with blood (oxidized regenerated cellulose)

Thin (Mickel 2003)

Testori 1999

Aspergillus fumigatus: Uses heavy metals (like zinc oxide--a growth factor for it) for proliferation & metabolism

Giardino, et al. JOE 2006 Jul


14 days post surgery

1. Incisional Wound

2. Dissectional Wound

3. Osseous Wound

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